Tommi Sulander

Self-rated health and indicators of SES among the ageing in three types of communities

Aims: This paper examines associations between self-rated health, three indicators of SES (self-reported education, disposable household income, adequacy of income) and three types of communities (urban, densely or sparsely populated rural areas) among ageing men and women in the Province of Päijät-Häme, Southern Finland. There is a lack of knowledge regarding the magnitude of community type when examining the relation between subjective health and SES. Methods: Cross-sectional questionnaire data gathered in the spring of 2002 for a prospective follow-up of community interventions were used. These data, together with a number of clinical and laboratory measurements, yielded the baseline for a 10-year community intervention study. A representative stratified (age, gender, area) sample of men and women living in the province and belonging to the birth cohorts 1926—1930, 1936—1940, and 1946—1950 was obtained from the National Population Registry. The target sample was 4,272, with 2,815 persons responding (66% response rate). Results: Positive associations between indicators of SES and self-rated health were observed in all three community types. After adjusting for other factors, adequacy of income showed the strongest (positive) association with self-rated health in urban areas in all age groups. A similar pattern of associations, with varying statistical significance, though, was found in the two rural areas. Conclusions: This study supports the view that while actual income is positively correlated to health, adequacy of income is an even stronger predictor of it. Thus, there was a significant link between better financial standing and good health among ageing people, especially in urban areas.

Self-rated Health and Social Capital Among Aging People Across the Urban–Rural Dimension

BackgroundPrevious studies have found self-rated health to be associated with social capital. However, there is lack of studies examining social capital among aging people and its impact on self-rated health in the urban–rural context.PurposeThe purpose of this study was to investigate associations between self-rated health and indicators of social capital (trust, various social contacts, social participation, and access to help) among aging people living in urban and rural areas in Finland.MethodA postal survey was conducted in 2002 among men and women born in 1926–1930, 1936–1940, or 1946–1950 and dwelling in 14 municipalities in the Päijät-Häme hospital district in Finland. A total of 2,815 participants represented 66% of the original stratified (by age, gender, and municipality) sample. Logistic regression analyses were used to examine the associations.ResultsActive social participation and easy access to help from others were associated with good self-rated health, especially in the urban and sparsely populated rural areas. Trust was a particularly important correlate of subjective health in the urban area, though its significance diminished after adjusting to all background variables. No overall disparities in self-rated health between the areas emerged. Social participation and access to help as indicators of social capital seem to be important resources when aging men and women assess their subjective health.ConclusionIncreasing efforts to encourage social participation and facilitate access to help from other persons should be included among the key priorities in community health promotion.

Register-based data indicated nonparticipation bias in a health study among aging people

OBJECTIVES To examine nonparticipation in a survey by linking it with register information and identify potential nonresponse bias of inequalities in health status among aging people. STUDY DESIGN AND SETTING Cross-sectional questionnaire survey with clinical checkups carried out in 2002 among persons born in 1926-1930, 1936-1940, and 1946-1950 in Southern Finland. The sample was linked with register information from Statistics Finland and analyzed in terms of participation and health status as measured by medicine reimbursements. RESULTS Participation in the survey was more frequent among those who were older, female, married or cohabiting, higher educated and nonurban residents, and those with higher income and moderate health. Among nonrespondents, women were less healthy than men, whereas among respondents, the results were reversed. Among nonrespondents, better income was associated with unfavorable health. Poor health was generally more common among nonrespondents than respondents in several subgroups. CONCLUSION Differences in response rates were found in sociodemographic factors, health, and socioeconomic position. Favorable health was generally more frequent among respondents than nonrespondents. In particular, health inequalities by gender and income differed between respondents and nonrespondents. Thus, nonresponse may lead to bias in analyses of health inequalities among aging people.

Functional ability in the elderly Finnish population: time period differences and associations, 1985—99

Aims: The aim of this study was to determine whether functional ability among 65- to 79-year-old Finnish men and women changed at population level from the 1980s to 1990s and how gender, age, previous occupation, and marital status are associated with functional ability and whether these associations have changed over time. Methods: Biennial surveys on health behaviour among Finnish elderly people were used to study 10,309 men and women from 1985 to 1999. Age, gender, previous occupation, and marital status were the demographic variables. Logistic regression was used to determine differences. Results: Functional ability deteriorated clearly with age, but was slightly better in the 1990s than 1980s. Gender differences of functional ability were small. Retired office employees had the best functional ability. Moreover, time changes of functional ability between occupational groups were a little more positive among men than among women. Functional ability of divorced and widowed elderly emerged as slightly worse than among married persons. Conclusions: Young age and non-manual occupation prior to retirement were associated with better functional ability. The overall improvement of self-reported functional ability among elderly people suggests that the onset of disabilities could be postponed, especially if health-related circumstances were more evenly distributed at the start of or even before retirement age.

Associations of self-rated health with different forms of leisure activities among ageing people

SummaryObjectives:This study examined associations between self-rated health and specific forms of leisure activities – i. e. singing in a choir, art painting, playing music; art exhibitions, theatre, movies, concerts; religious events; studying and self-development; voluntary work – and investigated how confounding factors contribute to these associations among ageing people in Finland.Methods:A postal survey was conducted in 2002 among men and women born in 1926–30, 1936–40 and 1946–50. The final 2,815 participants represented 66% of the original sample drawn, stratified by age, gender, and municipality. Logistic regression analyses were used to investigate associations between specific forms of leisure activities and self-rated health.Results:Going to art exhibitions, theatre, movies, and concerts among women and studying and self-development among men were significantly positively related to self-rated health, even after adjusting for socioeconomic status (SES), other sociodemographic variables, obesity, and health behaviours. Among women, active participation in religious events and voluntary work were negatively associated with self-rated health.Conclusions:The association of leisure activities and good self-rated health may differ for genders due to their nature or meaning. Partial support was found for the assumption that leisure activities go together with better self-rated health among ageing people.

The effect of trust and change in trust on self-rated health: A longitudinal study among aging people

This study examined whether trust predicted subsequent self-rated health over time at 3 years follow-up among aging people, and whether changes in trust were associated with self-rated health. Longitudinal, questionnaire-based data were collected from three age cohorts (born in 1926-1930, 1936-1940, and 1946-1950) living in the Province of Päijät-Häme, southern Finland. The response rate at the baseline in 2002 was 66% (n=2815). The follow-up was carried out in 2005, with 79% of eligible individuals participating (n=2216). Logistic regression analyses were used to derive the results. High trust was a strong predictor for good self-rated health at the follow-up. Adjusting for background variables, however, attenuated the association. In addition, good self-rated health was most common among men with sustained high trust, among women the association was somewhat weaker. Among men improvement in trust was associated with good self-rated health, but this correlation weakened after multiple adjustments. Thus, longitudinally trust is an important contributor to self-rated health among aging people. Moreover, improvement of trust but also the stability of high trust especially among men indicate better self-rated health. Trust has a positive effect on health and should therefore be seen as a significant element in health promotion.

Self-rated health (SRH) and socioeconomic position (SEP) among urban home-dwelling older adults

The main purpose of this study was to examine the association of education and adequacy of income with self-rated health (SRH) among home-dwelling older people aged 75 and over living in the urban area. A cross-sectional survey from 2008 was used to study 1395 older adults aged 75 and over living in one of the central areas of the city center of Helsinki, the capital of Finland. Associations of SRH with, education and adequacy of income were tested using ordinal regression model. Those with a lower level of education had higher level of poor health. Self-assessed adequacy of income had also a strong association with SRH. For the oldest respondents this association was even stronger than the association between education and SRH. Subjective evaluation of financial situation should be used as a key indicator of socioeconomic position (SEP) in studies examining inequalities in health especially among older adults.

Ten year trends in health inequalities among older people, 1993-2003

in old age is associated with increased mortality and hospitalization. Pelemans W. Serum transferrin receptor in the evaluation of the iron status in elderly hospitalized patients with anaemia. Role of transferrin, transferring receptors and iron in macrophage listericidal activity. Serum transferrin receptor assay in iron deficiency anaemia and anaemia of chronic disease in the elderly. Ten year trends in health inequalities among older people, 1993–2003 SIR—In most western societies, socioeconomic position operates as a powerful discriminator of health status and risk of premature mortality [1]. This pattern is visible throughout the life course from young people to the oldest old [2–9]. Self-rated health (SRH) has often been used in studies on health inequalities [1, 10], and it is recommended as a health measure by the WHO [11]. Associations of poor SRH with morbidity and mortality are well established among people with different ages. The associations have been shown to be maintained even when other health measures such as car-diovascular disease (CVD), diabetes, cancer and functional capacity are controlled [12–14]. Although studies of SRH among older people have gained prominence in recent years, the results lack coherence [9, 15– 18]. Studies concerning cohort changes in SRH have found both improved and deteriorated levels among older people [19]. A recent study from the US suggested a stable or a slightly improved level of SRH among older people from the early 1990s onwards [20]. Results from Sweden indicated stable figures of SRH among older people [9]. There has been a strong impetus for strategies to prevent CVDs in Finland [21]. In fact CVD mortality in Finland has declined considerably since 1970s. Results from Sweden have indicated some of the CVDs to be increased from the 1980s to the early 2000s among older population aged 65–84 years [22]. CVDs have also been found to be associated inversely with several indicators of SES, including education [23]. Reducing socioeconomic health inequalities has been a central goal in national public health programmes in several countries, including Finland [24], since the 1980s. Even though positive changes in health and functional ability have been found in many countries, health disparities have been either stable or slightly increasing among those of working age [25]. Less is known, however, about the trends of health inequalities among older people. A study from Sweden showed no changes in socioeconomic disparities in SRH among older people between the early 1990s and 2000s [9]. A …

The association of functional capacity with health-related behavior among urban home-dwelling older adults.

The present study was aimed to examine whether functional capacity among the urban home-dwelling older adults associates with health-related behavior. We also examined whether health-related behavior and certain diseases can be seen as mechanisms explaining socioeconomic disparities in functional capacity. A cross-sectional survey from 2008 was used to study 1395 older adults aged 75 and over living in one of the central areas of the city center of Helsinki, the capital of Finland. Associations of activities of daily living (ADL) with, smoking, food habits, physical activity, socioeconomic status and certain diseases were tested using ordinal regression model. Current smokers had slightly poorer functional ability than non-smokers among men. Those who did not use vegetables and/or fruits daily had a poorer functional capacity than daily users. Physically inactive respondents had clearly poorer functional capacity in comparison to active ones. Those with lower education had poorer functional status than higher educated irrespective of health-related behaviors and certain diseases. As health-related behaviors are modifiable, intervention programs should be targeted at all older adults with or without health problems.

Longitudinal changes in functional capacity: effects of socio-economic position among ageing adults

IntroductionHealth and functional capacity have improved especially in Western countries over the past few decades. Nevertheless, the positive secular trend has not been able to decrease an uneven distribution of health. The main aim of this study was to follow-up changes in functional capacity among the same people in six years time and to detect whether the possible changes vary according to socio-economic position (SEP). In addition, it is of interest whether health behaviours have an effect on these possible changes.MethodsThis longitudinal follow-up study consisted of 1,898 individuals from three birth cohorts (1926–1930, 1936–40, 1946–50) who took part in clinical check-ups and answered to a survey questionnaire in 2002 and 2008. A sub-scale of physical functioning from the RAND-36 was used to measure functional capacity. Education and adequacy of income were used as indicators of socio-economic position. Repeated-measures ANOVA was used as a main method of analysis.ResultsPhysical functioning in 2002 and 2008 was poorest among those men and women belonging to the oldest cohort. Functional capacity deteriorated in six years among men in the oldest cohort and among women in all three cohorts. Socio-economic disparities in functional capacity among ageing people existed. Especially lower adequacy of income was most consistently associated with poorer functional capacity. However, changes in functional capacity by socio-economic position remained the same or even narrowed independent of health behaviours.ConclusionSocio-economic disparities in physical functioning are mainly incorporated in the level of functioning at the baseline. No widening socioeconomic disparities in functional capacity exist. Partly these disparities even seem to narrow with ageing.